Clinical Outcomes and Radiologic Changes Following Microsurgical Bilateral Decompression via a Unilateral Approach in Patients With Lumbar Canal Stenosis and Grade I Degenerative Spondylolisthesis With a Minimum 3-year Follow-up.

By London Spine
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Clinical Outcomes and Radiologic Changes Following Microsurgical Bilateral Decompression via a Unilateral Approach in Patients With Lumbar Canal Stenosis and Grade I Degenerative Spondylolisthesis With a Minimum 3-year Follow-up.

J Spinal Disord Tech. 2012 Oct 15;

Authors: Jang JW, Park JH, Hyun SJ, Rhim SC

Abstract
STUDY DESIGN:: A retrospective study. OBJECTIVE:: To analyze the clinical outcomes and radiologic changes following microsurgical bilateral decompression via a unilateral approach in patients with lumbar canal stenosis and degenerative spondylolisthesis. SUMMARY OF BACKGROUND DATA:: Satisfactory short-term results have been observed following minimally invasive decompressive procedures, but intermediate and long-term outcomes have not been assessed. It is not yet clear whether decompressive laminectomy with concomitant fusion is the optimal surgical treatment for spinal stenosis combined with mild degenerative spondylolisthesis. We therefore evaluated minimum 3-year clinical outcomes and radiologic changes in patients with lumbar canal stenosis and grade 1 degenerative spondylolisthesis who underwent microsurgical bilateral decompression via a unilateral approach, without fusion. METHODS:: We assessed 21 consecutive patients who underwent surgery conducted by a single surgeon of our hospital, between 2005 and 2007. The Oswestry Disability Index (ODI) was determined preoperatively, just before discharge, and at last follow-up. Plain dynamic x-rays were used to determine slip percentages. RESULTS:: Average patient age and clinical and radiologic follow-up periods were 67 years, 49.3 months, and 18 months, respectively. Preoperative, immediate postoperative, and last follow-up average ODIs were 59.52±9.00, 50.19±7.23, and 26.19±12.42, respectively. But one patient experienced aggravated symptoms and later underwent a fusion procedure. Of the 22 levels with spondylolisthesis, 15 had no sagittal motion as the difference in slip percentage on dynamic x-rays but 7 showed sagittal motion. Average slip percentages increased from 13.90±5.41% to 14.60±5.78% for levels without sagittal motion on dynamic x-ray and from 13.12±3.48% to 18.58±4.55% for levels with sagittal motion. CONCLUSIONS:: Despite small case series with retrospective design and the absence of a control group, our study suggest that bilateral decompression via a unilateral approach in patients with lumbar spinal stenosis and grade 1 degenerative spondylolisthesis showed good mid-term clinical outcomes, despite an increase in slip percentage.However, more marked increases in slippage were observed in patients with sagittal motion in spondylolisthesis levels on preoperative dynamic x-ray than in patients without sagittal motion. Therefore bilateral decompression via a unilateral approach can aggravate symptom related to instability in patients with preoperative sagittal motion on dynamic x-ray and needs longer term follow-up than in our study.

PMID: 23073148 [PubMed – as supplied by publisher]

Microsurgical extraforaminal decompression of lumbar root canal stenosis.

By London Spine
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Microsurgical extraforaminal decompression of lumbar root canal stenosis.

Oper Orthop Traumatol. 2013 Feb;25(1):16-30

Authors: Papavero L, Kothe R

Abstract
OBJECTIVE: To decompress the lumbar spinal nerve impinged peripherally to the lateral recess. To avoid in selected cases the pedicle screw fixation and fusion of the segment. INDICATION: Single level radiculopathy in degenerative scoliosis or in degenerative disc disease without segmental instability. CONTRAINDICATIONS: Scoliosis > 30° at the index level, lateral listhesis > 6 mm, mobile vertebral slip. SURGICAL TECHNIQUE: Microscope from skin to skin. A 35-mm skin incision about 40 mm off the midline. Transmuscular access by blunt splitting of the paravertebral muscles pointing about 40° towards the midline. Insertion of an expandable tubular retractor or of a speculum counter retractor system. Dissection of the target lumbar nerve in the midst of the extraforaminal fat tissue. Enlargment of the root canal mostly by drilling and using thin foot plate punches. The nerve is decompressed from peripherally to the lateral rim of the yellow ligament. Closure by layers. Drainage is usually not required. POSTOPERATIVE MANAGEMENT: Same day mobilization. RESULTS: The clinical results in 22 cases (15 men) of extraforaminal nerve root involvement were studied. Because of the very selective indication the patients were recruited over a 3-year time-span. The mean age was 64 years (range 50-82 years). An independent follow-up examination was performed 3 months and 1 year following surgery. The mean FU was 27 months (range 41-22 months). According to the modified MacNab criteria, the results were excellent (45%), good (23%), fair (14%), and poor (18%). Four patients underwent second surgery for pedicle screw fixation and fusion. Persistent low back pain was the most common cause of an unsatisfactory postoperative course.

PMID: 23381738 [PubMed – as supplied by publisher]

[Selective, microsurgical cross-over decompression of multisegmental degenerative lumbar spinal stenoses : The “Slalom” technique].

By London Spine
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[Selective, microsurgical cross-over decompression of multisegmental degenerative lumbar spinal stenoses : The “Slalom” technique].

Oper Orthop Traumatol. 2013 Feb;25(1):47-62

Authors: Mayer HM, Heider F

Abstract
OBJECTIVE: Selective, bilateral multisegmental microsurgical decompression of lumbar spinal canal stenosis through separate, alternating cross-over approaches.
INDICATIONS: Two- and multisegmental degenerative central and lateral lumbar spinal stenoses.
CONTRAINDICATIONS: None (however, if stabilization is necessary, the Slalom technique is not possible).
SURGICAL TECHNIQUE: Minimally invasive, muscle-sparing and facet-joint-sparing bilateral decompression of the lumbar spinal canal through 2 or more alternating microsurgical cross-over approaches from one side.
POSTOPERATIVE MANAGEMENT: Early mobilization 4-6 h postoperatively. Soft lumbar brace for 4 weeks (optional).
RESULTS: Between December 2010 and May 2011, the operation was performed in 35 patients (10 women; 25 men; age 71.8 years). The average time of surgery was 42 min/segment, the average blood loss was 20.3 ml/segment. Of the 35 patients, 15 did not required wound drainage. All patients were mobilized without restriction after 4-6 h, hospitalization was 5.2 days. There were 3 intraoperative complications (2 Dura lesions [5.7%] and 1 temporary L5 radiculopathy probably due to swelling of the L5 nerve root [2.8%]). Postoperatively there was a significant improvement in quality of life as measured with EQ 5D and Oswestry Disability Index as well as a significant improvement of walking distance and standing time.

PMID: 23400667 [PubMed – in process]